Stroke: Therapy

Question 1

How many neurons does a patient with an untreated stroke lose each minute?

Answer 1

1.9 million

Question 2

What does benefit from thrombolysis decrease with?

Answer 2

Time

Question 3

What should you not give to someone with a haemorrhagic stroke?

Answer 3

Alteplase

Question 4

What is alteplase?

Answer 4

Fibrinolytic agent

Question 5

What does alteplase do in a stroke?

Answer 5

• Cause unexpected bleeding either in the brain if tissue has established damage or elsewhere
• If brain tissue is already dead then restoring blood supply is not going to help

Question 6

What are the SIGN guideline regarding thrombolysis?

Answer 6

• Thrombolysis should be administered within the context of an acute stroke service.
• Local protocols for the administration of thrombolytic therapy should be developed.

Question 7

According to SIGN guidelines what should patient with suspected stroke have?

Answer 7

• Ambulance priority with blue light
• Rapid triage on arrival to hospital
• Immediate access to specialist stroke services
• Rapid brain imaging
• Rapid specialist assessment

Question 8

When may patients with neurological deficit be suitable for thrombolysis?

Answer 8

If they are scanned within 4-5 hours of symptom onset

Question 9

What are the contraindications to thrombolysis?

Answer 9

• Age <16 + >80
• Hypertension
• Recent bleeding
• Clotting disorder
• Alergy

Question 10

Who should be offered a hemicraniectomy?

Answer 10

For individuals aged up to 60 who suffer an acute MCA territory ischaemic stroke complicated by massive cerebral oedema, surgical decompression by hemicraniectomy should be offered within 48 hours of stroke onset

Question 11

Why are stroke units important?

Answer 11

• Mobilise ASAP
• Concentrate on simple things like swallowing and positioning
• Early therapy
• Concentrating of expertise

Question 12

How does the aetiology of a TIA differ from a definite stroke?

Answer 12

No difference

Question 13

TIA

Answer 13

Transient Ischaemic Attack
-Warning stroke/mini stroke with stroke like symptoms persisting less than 24 hours that clears without residual disability

Question 14

How can the risk of recurrent stroke be decreased following a TIA?

Answer 14

Early treatment including the evaluation and initiation of treatment in a specialised outpatient clinic

Question 15

What secondary prevention is available for stroke?

Answer 15

• Clopidogrel or aspirin + dipyridamole
• Statin
• Anti-hypertensives
• Carotid endarterectomy

Question 16

When would surgery be considered for carotid stenosis?

Answer 16

• Anterior circulation
• TIA or stroke with good recovery
• 70% occlusion